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General NPI Number Information
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NPI Number | 1497928931
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Entity Type | Individual
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Provider Name | LISA MELNIK PEARSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 1 BLACHLEY RD
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City | STAMFORD
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State | CT
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Zip | 06902-0002
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Country | US
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Telephone | 203-705-0715
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Fax | 203-705-0717
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Provider Business Mailing Address
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Address Line | PO BOX 29234
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City | NEW YORK
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State | NY
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Zip | 10087-9234
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Country | US
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Telephone | 203-705-0715
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Fax | 203-705-0717
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3649
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 013905
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 3649
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License Number State | CT
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